Mechanical oscillopsia after lower eyelid blepharoplasty with fat repositioning.

Blepharoplasty with fat repositioning is a technique used to fill the tear trough in the aging lower eyelid. We describe a patient who underwent transcutaneous lower eyelid blepharoplasty with fat repositioning who subsequently developed mechanical oscillopsia in the right eye exacerbated by facial movement. Surgical exploration revealed cicatrix between the inferior oblique muscle and the anterior superficial musculoaponeurotic system. Excision of the scar bands led to immediate amelioration of symptoms. When performing blepharoplasty with fat repositioning, it is essential to be aware of the anatomic location of the inferior oblique in the anterior inferomedial orbit to avoid incarceration of this muscle.

Worsening angle closure glaucoma and choroidal detachments subsequent to closure of a carotid cavernous fistula.

BACKGROUND: Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the external or internal carotid arteries. Although rare, closure of carotid cavernous fistulas can lead to immediate ocular complications. To our knowledge, our case represents the first report of worsening angle closure glaucoma and choroidal detachments over an extended period of two months subsequent to closure of a carotid cavernous fistula. CASE PRESENTATION: A 70-year-old female with a history of primary angle closure glaucoma presented with 4 mm of proptosis, resistance to retropulsion, tortuous corkscrew blood vessels and an orbital bruit of the right eye. Diagnostic cerebral angiogram showed a small indirect Barrow type D right carotid cavernous fistula. Transarterial embolization was planned but repeat cerebral angiography prior to the procedure demonstrated spontaneous partial closure of the carotid cavernous fistula and the procedure was aborted. One month later, our patient was noted to have worsening vision and choroidal detachments of the right eye. She declined further testing and was thus started on self-administered manual carotid jugular compressions. One month later, she developed progressive worsening of her choroidal detachments and angle closure. She eventually opted for surgical intervention but repeat cerebral angiography showed significant thrombosis of the carotid cavernous fistula and no intervention was warranted. Examination two months later showed complete resolution of the choroidal detachments and open angles of both eyes. CONCLUSIONS: Our patient demonstrated worsening angle closure glaucoma and choroidal detachments after spontaneous closure of her carotid cavernous fistula had been noted. Ocular complications, including acute angle closure, have been reported to occur immediately after closure of carotid cavernous fistulas, but not over months as in our patient. It is imperative that individuals who have undergone apparent closure of a carotid cavernous fistula be carefully monitored for worsening ocular complications.

Structural and refractive outcomes of intravitreal ranibizumab followed by laser photocoagulation for type 1 retinopathy of prematurity.

PURPOSE: To evaluate refractive and structural outcomes for patients treated for retinopathy of prematurity (ROP) with the anti-vascular endothelial growth factor (anti-VEGF) agent ranibizumab and "delayed laser," defined as any laser photocoagulation treatment administered at least 2 weeks and <1 year after the initial anti-VEGF injection. METHODS: The medical records of infants with type 1 ROP treated between 2015 and 2020 with intravitreal 0.25 mg ranibizumab followed by delayed laser photocoagulation, with a minimum of 6 months' follow-up, were reviewed retrospectively. Refractive and structural outcomes were extracted from the record. RESULTS: A total of 68 eyes of 34 neonates were included, with median gestational age of 24 weeks and birthweight of 657 g. Patients were aged 0.9 to 4.4 years at last follow-up; mean follow-up interval was 2.7 ± 1.02 years. There was no progression to stage 4 or 5 following treatment during the study period. At 2 years' follow-up (mean age, 2.41 ± 0.23 years), median spherical equivalent (SE) was -0.13 D (IQR, 4.20 D). At most recent examination (mean age, 2.70 ± 1.02 years), the most common ocular findings included strabismus (32%), optic atrophy (24%), amblyopia (21%), high myopia (7%), and nystagmus (4%). CONCLUSIONS: In our small cohort, neonates with type 1 ROP treated with intravitreal ranibizumab and delayed laser demonstrated good structural outcomes, with no progression to retinal detachment. We found lower rates of high myopia compared with previous reports of laser photocoagulation monotherapy.

Mesenteric rheumatoid nodules masquerading as an intra-abdominal malignancy: a case report and review of the literature.

BACKGROUND: Rheumatoid nodules are the most common extra-articular findings in patients with rheumatoid arthritis. They occur most commonly at pressure points such as the extensor surfaces of the forearms, fingers, and occiput, but have also been reported to occur in unusual locations including the central nervous system, pericardium, pleura, and sclera. We present the unusual case of rheumatoid nodules in the small bowel mesentery masquerading as an intra-abdominal malignancy. CASE PRESENTATION: A 65-year-old-male with a known history of longstanding erosive, nodular, seropositive rheumatoid arthritis was incidentally found to have a mesenteric mass on computed tomography (CT) exam of the abdomen. This mass had not been present on prior imaging studies and was worrisome for a malignancy. Attempts at noninvasive biopsy were nondiagnostic but consistent with a "spindle" cell neoplasm. Laparotomy revealed extensive thickening and fibrosis of the small bowel mesentery along with large, firm nodules throughout the mesentery. A limited bowel resection including a large, partially obstructing, nodule was performed. Pathology was consistent with an unusual presentation of rheumatoid nodules in the mesentery of the small bowel. CONCLUSION: Rheumatoid nodules should be considered in the differential diagnosis of a patient who presents with an intra-abdominal mass and a history of rheumatoid arthritis. Currently, no tests or imaging modality can discriminate with sufficient accuracy to rule out a malignancy in this difficult diagnostic delimma. Hopefully, this case will serve as impetus for further study and biomarker discovery to allow for improved diagnostic power.

Effects of siblings on reproductive maturation and infanticidal behavior in cooperatively breeding Mongolian gerbils.

Mongolian gerbils living with their natal families undergo delayed reproductive maturation while helping to rear their younger siblings, whereas those housed away from their natal families may mature earlier but often respond aggressively to unfamiliar pups. We tested whether cohabitation with pups contributes to reproductive suppression and inhibition of infanticidal behavior, using young males and females housed with (1) their parents and younger siblings (pups), (2) parents without pups, (3) mixed-sex littermate groups, or (4) mixed-sex groups of unrelated peers. Maturation in males was inhibited by cohabitation with the parents, while maturation in females was further suppressed in the presence of pups. Males in all housing conditions showed little aggression towards unfamiliar pups, whereas females were usually infanticidal unless housed with pups. Aggression toward pups was especially pronounced in females that were pregnant or undergoing ovulatory cycles. Thus, cohabitation with younger siblings may intensify reproductive suppression and inhibit infanticidal behavior in female gerbils, whereas male gerbils exhibit parentally induced reproductive suppression and low rates of infanticide even in the absence of younger siblings.

Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema.

PURPOSE: To evaluate the efficacy of micropulse laser in the early treatment of diabetic macular edema (DME) and its associated burden of anti-vascular endothelial growth factor (VEGF) injections. METHODS: This retrospective comparative study compared a group of 19 eyes with DME treated with micropulse laser to a matched control group of 19 eyes with DME treated with ranibizumab injections without micropulse laser. Recorded parameters included previous medical and ocular history, previous and subsequent ranibizumab injections administered for DME, visual acuity (VA), central macular thickness throughout the follow-up period, and the occurrence of any complications. RESULTS: The improvement in VA was comparable in both groups, at 12 months and at the final follow-up. Patients treated with micropulse laser required significantly fewer ranibizumab injections than their controls, both at 12 months (1.7 ± 2.3 vs 5.6 ± 2.1) and by the end of the follow-up (2.6 ± 3.3 vs 9.3 ± 5.1) (p<0.001 for both). No complications related to the micropulse laser were encountered. CONCLUSIONS: Micropulse laser is a safe and effective treatment for DME, which may achieve comparable improvement in VA along with a significant reduction in the burden of anti-VEGF injections. We suggest a treatment approach for its inclusion in the early stages of DME.

Cardinal features of superior oblique myokymia: An infrared oculography study.

PURPOSE: Superior oblique myokymia (SOM) is a rare eye movement disorder characterized by unilateral oscillopsia and binocular diplopia. Our study aimed to better understand SOM using infrared oculography. METHODS: We examined and recorded five patients with SOM. RESULTS: Binocular infrared oculography showed that in primary gaze, all patients exhibited torsional oscillations, which worsened in infraduction and abduction and improved in supraduction and adduction. Saccades showed increased downward saccade amplitudes but normal peak velocities. During fixation in primary gaze, removal of target led to extorsion and supraduction, unmasking underlying superior oblique weakness. CONCLUSIONS AND IMPORTANCE: Our data suggest both weakness and activity-dependent hyperactivity of the trochlear motor unit, supporting a model of injury followed by aberrant regeneration.

Acute Retinal Necrosis Presenting in Developmentally-delayed Patients with Neonatal Encephalitis: A Case Series and Literature Review.

We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients' inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.

Two-Year Anatomical and Functional Outcomes After Macular Hole Surgery: A Prospective, Controlled Study.

BACKGROUND AND OBJECTIVE: To determine 2-year anatomical and functional outcomes after macular hole (MH) surgery. PATIENTS AND METHODS: The surgical eye (SE) and fellow eye (FE) of 10 patients undergoing MH surgery were examined preoperatively and at 3, 12, and 24 months postoperatively. Retinal nerve fiber layer (RNFL), external limiting membrane (ELM), inner segment/outer segment (IS/OS) junction, cone outer-segment tips (COST) line, and ganglion cell inner plexiform layer (GCIPL) thickness were analyzed on spectral-domain optical coherence tomography. RESULTS: Inferior peripapillary RNFL was thinner in the SE at 110 ± 12.2 versus 123 ± 9.82 for FE (P < .05). Defect size in ELM (r = 0.61; P < .001), IS/ OS (r = 0.67; P < .001) junction, and COST (r = .67; P < .001) line correlated with visual recovery. Average GCIPL was thinner in SE compared to FE (P < .05). CONCLUSION: Eyes after MH repair demonstrated inferior RNFL and GCIPL thinning. Defect size in ELM, IS/OS junction, and COST line predicted visual recovery.

Tropheryma whipplei Crystalline Keratopathy: Report of a Case and Updated Review of the Literature.

Purpose. To report a case of Tropheryma whipplei infection with crystalline keratopathy and review the recent literature on the presentation, diagnosis, and management of Whipple's disease. Methods. Detailed case presentation and extensive literature search of Pubmed for all years through February 2012 using the following search terms: Whipple's disease, Tropheryma whipplei, corneal deposits, crystalline keratopathy, and uveitis. Relevant articles were retrieved and analyzed. English abstracts were used for non-English articles. Cross-referencing was employed and reference lists from selected articles were used to identify additional pertinent articles. Results. Diagnosis of Whipple's disease remains challenging and untreated infection can result in mortality. Ocular signs and symptoms are usually nonspecific, but several independent cases have reported the presence of intraocular crystals or crystalline-like deposits. Conclusions. The presence of intraocular crystals or crystalline-like deposits may be an identifying feature of ocular Whipple's disease.

Integra Bilayer Matrix Wound Dressing closure of large periorbital traumatic wound.

We report the first use of the Integra Bilayer Matrix Wound Dressing (Integra LifeSciences Corp), a collagen sheet with glycosaminoglycans and a silicone layer, in an innovative reconstruction approach to devastating traumatic tissue loss in the periocular area. A 36-year-old woman was involved in a motor vehicle crash with a resultant large defect from the medial canthus to the temporal fossa and from the pretarsal skin to the brow. There was denudation of skin and soft tissue to the bone at the superolateral orbital apex. The severity of tissue loss precluded placement of an autograft or allograft; thus, a skin substitute was instead used, with a successful reconstructive outcome. Application of the newer bioengineered skin products for full-thickness skin wounds should be considered for reconstruction of the periocular area.

Polycarbonate membrane impression cytology: evidence for fluorescein staining in normal and dry eye corneas.

BACKGROUND/AIMS: Corneal impression cytology is usually performed with mixed cellulose ester membranes and a limited array of stains. A method using polycarbonate membrane air-dried preparations led to the discovery of fluorescein staining in cells from patients with and without dry eye disease and a membrane-induced defect that was not due to cell removal. METHODS: Impressions after fluorescein installation were performed using polycarbonate and mixed cellulose ester membranes with rapid staining protocols for Diff-Quick as well as haematoxylin and eosin stains. Prior to staining the air-dried material was examined for fluorescence. RESULTS: Epithelia of both normal and dry eye corneas retained fluorescence from clinical instillation of fluorescein. Corneal defects created by the polycarbonate membrane could not be explained by membrane-induced cell removal. After rapid staining, polycarbonate membranes revealed less background, dissolved easily prior to coverslip application, but showed lower cellular yield compared with the mixed cellulose membranes. CONCLUSION: Polycarbonate membrane impression cytology enables immediate assessment with rapid stains. Topically applied fluorescein penetrates corneal epithelial cells in both normal and dry eye patients. Cells fluoresce on the cytology membranes. The impression-induced defect on the cornea is not due to cell stripping and may represent removal of mucins.